Are Medicare Supplement Plans Worth It?

The average Medicare Supplement Plan costs a lot more than the average Medicare Advantage plan, yet many of my clients choose to pay more and purchase a Connecticut Medicare Supplement Plan. Those who choose the more expensive option do so because they want more in one of two areas. The want more coverage or they want more doctors available to them.

Medigap Plans Offer Better Coverage

In most situations, you will have lower copays or cost shares if you enroll in a Medigap policy instead of a Medicare Advantage policy. However, that isn’t always true. Nor is this the biggest difference not to enroll in one of the $0 premium Medicare Advantage plans.

The difference in coverage isn’t as great as many people assume when the see the big difference in price. The biggest difference is the network doctor restrictions.

If you are comfortable with these restrictions, I say, save the money. If not, you should explore Medigap plans.

Most of my clients are happy with the network restrictions so long as their doctors are in the network. If you want to see if any of the plans have your doctors in their network, request CT Medicare insurance quotes and recommendations from me and enter your doctors’ information on the questionnaire.

Medicare Advantage vs Medigap Plans – Network Restrictions.

CT Medicare Supplement Plans

If you enroll in a Medicare Supplement Plan, you will not have any network restrictions. This means you can see any doctor or provider who accepts Medicare. If the plan has a copay, you will pay the same copay for all doctors. If the plan requires you to pay a percentage of the visit’s cost, your percentage will be the same for all providers who accept Medicare. For some plans the percentage you pay is zero.

CT Medicare Advantage Plans

Medicare Advantage medical insurance plans do have network restrictions. Unless you seek care during a medical emergency, you can expect to pay more when you are out of network. In most cases, you will pay the full cost for your treatment.

Most Medicare Advantage Plans available to Connecticut residents are HMOs. These plans have the most severe network restrictions. If you visit in-network doctors or other in-network providers, you will probably pay only a small copay. However, if you seek care from a non-network provider, you will pay the full cost for the treatment, unless you are having a medical emergency.

A few CT Medicare Advantage plans are PPOs or POS plans. With these plans, you may get reimbursement for out-of-network visits.

But you will pay more than you would have if you’d received the same treatment from an in-network physician or other provider. You may pay a higher copay. You may pay a percentage of the doctor visit instead of a copay. Your visit may be subject to a deductible that does not apply to in-network visits. Your company may use any combination of these cost shifting strategies when you visit doctors out of network.

The average cost of Medicare Advantage Plans is so low that I recommend them more often than the CT Medigap plans. However, there are many instances when even a $0 premium health insurance plan will cost more overall than one of the more expensive Supplement plans.

There a few questions I like to ask you if you choose me to be your agent. The answers will help us determine which type of plan will be best for you.

Are all your doctors in-network?

How much time will you spend out of state?

Do you meet the criteria for Qualified Medicare Beneficiary status?

Are All Your Doctors In-Network?

If we can’t find a Medicare Advantage plan that has all your doctors in its network and you aren’t willing to change doctors, your choices are limited.

You can pay the full cost of each visit to any doctors who are not in the network

You can purchase a PPO plan that may pay something towards out of network treatment

You can purchase a Medicare Supplement Policy

How Much Time Do You Spend Out-Of-State?

If you are unlikely to need anything besides emergency care when away from home, a Medicare Advantage plan will probably meet your needs. We can almost always find one that has all your doctors in their network. All plans cover emergency care in any state.

However, if you have a second home in another state and will spend months there, you should probably choose a Medigap plan. Any of the Connecticut Medicare Supplement (Medigap) Plans will cover you in any state.

You won’t necessarily need to buy a Medicare Supplement just because you are a snowbird. You may be in such good shape that you feel confident that you won’t need any non-emergency medical visits even if you will be away from Connecticut for six months or more. Or we may be able to find a plan that has a network in both states.

Do You Meet the Criteria for Qualified Medicare Beneficiary Status?

If your income meets the guidelines, you may qualify for a Medicare Advantage plan with benefits that are better than the best Medicare Supplement Plan available in CT. If this is the case, unless you will need out-of-network care, I will probably recommend against a Medigap plan.

If you want my help answering the question “which Medicare Supplement plan is best for me? or are leaning towards a Medicare Advantage plan and want my advice, you can request that I email you a recommendation.

When you complete my questionnaire, be sure to have a list of your doctors and medications handy. The free service I provide includes researching both your doctor and your medicines to find the best plan for you whether it is one of the $0 premium medicare advantage plans or a Connecticut Medicare Supplement Plan.

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[…] Are Medicare Supplement plans worth it? You may feel the higher cost of Medicare Supplement Plan F, when compared to that of an Advantage plan is justified by the freedom to see any doctor who accepts Medicare. […]